Alerting professionals to signs of emotional abuse

Social workers are used to detecting the signs of physical and sexual abuse and taking prompt action to protect a child. But how and when should they respond to indications of emotional abuse where there is no “forensic” evidence and the impact of parent-child interactions may not be apparent from an initial assessment?

This is not a new dilemma, but one that continues to trouble practitioners. Dr Danya Glaser, a child and adolescent psychiatrist at Great Ormond Street Hospital, says social workers need “collateral information” to conclude whether interactions are typical of a relationship and potentially harmful. She emphasises that it is therefore impossible for social workers to base a conclusion of emotional abuse on a single visit.

Dr Chris Hobbs, consultant paediatrician at St James Hospital in Leeds, believes certain signs should alert practitioners to the possibility of emotional abuse. “When we see children who are failing to thrive – and who are sometimes obese – and there is no medical cause, we find that there are often subtle, and sometimes not so subtle, interactions that take place between the carers and the child,” he says. “When the parent calls the child ‘greedy’ or says he is ‘like a pig’ or steals food then our hearts sink because this tells us about how the child is viewed. The child who is emotionally starved will not grow and develop normally.”

Build the jigsaw

Hobbs urges practitioners to “build the jigsaw by talking to other professionals and by looking back over time”. He says practitioners should strive to observe family interaction, possibly from behind a screen.

But while the government’s definition of emotional abuse emphasises the “persistence” of a harmful interaction (see Emotional Abuse defined), child protection measures coupled with the performance agenda imposed on social workers and an increased administrative workload give practitioners less time to spend with families and restricts evidence-gathering.

Glaser says that in both physical abuse, where signs are detected in the child, and sexual abuse, where evidence is often gleaned from accounts from the child, protection procedures work because they are geared to finding evidence and intervening immediately. But she argues that this model does not fit with emotional abuse because it is a process not an event, and social workers should be working towards changing the parent-child interaction.

Janet Lee, a training consultant in child care practice who runs courses for social workers and their managers on emotional abuse, says practitioners have “a real struggle in evidencing emotional abuse” and can be uncertain about thresholds.

Emotional Abuse

She says social workers often see things in families that they worry about, but are unsure whether they constitute emotional abuse. “They may see a parent insulting their child, denigrating them and offering extreme punishments, but they have to make a judgement about whether the parent is having a bad day or whether it is part of a bigger picture,” Lee says.

She agrees that identification of emotional abuse requires time to build a relationship with a family and to observe interactions. “This requires longer-term social work, which is increasingly unfashionable in current social work practice while the government’s performance agenda and budgetary constraints dominate,” Lee says.

“What happens in practice is that social workers will do brief assessments and then may refer the family on for services which require the family to complete tasks or attend sessions with several professionals.

“What the family is likely to find more helpful is to receive that old-fashioned thing called social work, which is working intensively with the family on relationships and family dynamics, and trying to create change to improve the circumstances for the child.”

These concerns are borne out by the experience of a social worker (who does not wish to be named) in north west England who says that, although the government has introduced scales for assessing neglect, guidance on emotional abuse is vague.

Changing roles

She says that when she joined the profession six years ago, more time could be spent building relationships with families, with visits often weekly. However, with the pressure of administrative work and introduction of a new computer system, “performance indicators are now seen as being more important than actually getting out there and doing social work”.

She adds: “We are becoming more like case managers than social workers, and I am having to rely on our children and family workers to feed back information on families.”

Glaser says budget constraints mean that some council referral and assessment teams are overwhelmed because they have to come up with an initial assessment within seven working days. She says seeing a family for just 45 minutes is inadequate and that cases of emotional abuse would be better placed in the hands of more in-depth teams.

Sylvia Boulton, a family therapist for Nottingham child and adolescent mental health service, says that, in the absence of forensic evidence, social workers need “robust forensic thinking” because the biggest dilemma they face is determining whether the threshold for emotional abuse has been reached.

She has played a key role in the development of Nottinghamshire’s Multi Agency Forum on Emotional Abuse, which brings together a range of clinical professionals, social care staff and a head teacher. It produced multi-agency practice guidance on emotional abuse last year under the auspices of the local safeguarding children’s boards of Nottingham City and Nottinghamshire (see Nottinghamshire Model). The forum also offers case consultation so that practitioners can seek advice on specific cases, and provides interagency training on emotional abuse.

But for better identification and handling of cases of emotional abuse to become widespread, other councils will need to follow Nottinghamshire’s lead and develop their own multi-agency forums to help practitioners over the hurdles on the way. Nottinghamshire’s practice guidance is probably a good starting point – and undoubtedly an invaluable resource for children and families social workers.

According to the multi-agency practice guidance on emotional abuse produced by Nottinghamshire’s Multi Agency Forum on Emotional Abuse, there are three main ways that the issue may come to the attention of professionals:

● Concerns about parental behaviour

Children’s professionals may witness difficult parental behaviour towards a child, such as a child being persistently blamed for everything that goes wrong, persistent shouting and rejection.

● Concerns about parental attributes

Staff working in adult mental health, alcohol and drug addiction services may become concerned about how a parent is functioning and the impact this may have on their child.

● Concerns about the child

Professionals may be concerned about how a child is presenting – perhaps if they are unhappy, are bedwetting or poorly behaved – as this may be due to difficult relationships at home.

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